Likarska sprava

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ISSN / EISSN : 1019-5297 / 2706-8803
Total articles ≅ 214
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Khrystyna Pronyuk, Andriy Vysotskyi
Likarska sprava pp 3-12; doi:10.31640/jvd.5-6.2020(1)

Abstract:
During COVID-19 pandemic Lung ultrasound has rapidly become a tool for diagnosis and monitoring of lung involvement and it’s severity. Accurate evaluation of lung pathologic entities at the bedside, especially in critically ill patients, and those on mechanical ventilation, remains problematic. CT should not be frequently repeated and is not available everywhere, especially for critically ill patients. Limitations of bedside chest X-ray have been well described and lead to poor-quality X-ray films with low sensitivity.The lung ultrasound has been shown to be a useful tool in intensive care patients with adult respiratory distress syndrome (ARDS) and can be used forassessing severity of lung involvement in COVID-19. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. There have been shown that lung ultrasound can predict the deterioration of the patient's conditionand can be used for risk stratification and clinical decision making, reducethe use of both chest x‐rays and computer tomography, what is very important especially in limited resources settings.
E. I. Dubrovskyi, B. V. Dons’Koi
Likarska sprava pp 3-8; doi:10.31640/jvd.3-4.2020(1)

Abstract:
Introduction. This article is devoted to determining the level of protective antibodies of the patients at the early and further stages after being suffered from COVID-19. Materials and methods. On the first stage of the research 66 patients of different age and gender were examined. All patients, with no exception, had positive PCR results on COVID-19. All patients were relatively divided into two age groups: from 18 to 39 (n = 39) and from 40 to 65 (n = 27). The light form of disease was detected in 40 patients, the moderate form – in 15 and the severe one – in other 3 patients. 8 people were ill without symptoms. There were 11 patients hospitalized at the department of infectious diseases of the hospital. Afterwards the level of the antibodies was controlled on the 60th, 90th and 150th day after the onset. All patients were tested for antibodies to COVID-19 by enzyme-linked immunosorbent assay (ELISA) performed on the equip- ment: enzyme-linked immunosorbent assay Tecan (Austria); PW 40 Microplate Washer (France). ELISA set for serology COVID-19 test system IgG SARS-CoV-2 VitroTest (Ukraine). Results. Analyzing the data obtained via laboratory research, it can be seen that the immune response to COVID-19 was formed in 82 % of the examined patients. The maximum level of antibodies, which remains as such up to 40th day. Results. IgG increases from 12 to 40 days and then has not changed significantly for 60; 90 and 150 days. Only 4 patients had a noticeable decrease on day 150 (however, they still had a positive level). Conclusion. IgG levels in patients with Sars-Cov2 remain high for at least 150 days. The formation of antibodies is not affected by the age difference, neither depends on the severity of the disease.
I. S. Lembryk, O. V. Tymoshchuk
Likarska sprava pp 36-41; doi:10.31640/jvd.1-2.2020(5)

Abstract:
Introduction. During the last twenty-five years the occurrence of obesity in children and teenagers has increased significantly. Materials and methods. 110 adolescents of 12–17 years old, with alimentary-constitutional obesity and involvement of pancreas and without its injury, as compared to the 30 healthy children of control group, were examined. The research provided determination of the sizes and elasticity of pancreas. The detection of the total cholesterol, high density lipoproteins and leptin level was carried out. Intensity of clinical symptoms (spastic pain in epigastrium and left subcostal arc; abdominal pain without localization, vomit without relief, general weakness) have been made accordingly to sum of points (from 0 to 3 points). If sum of points makes from 0 to 2 – intensive character of abdominal pain is low, from 3 to 5 points – it is high, from 5 to 10 points – it is very high. Normal level of amylase in a blood serum (Karavey’s method) is 12–32 g/(hour l), аnd diastase in urine – 20–160 g/(hour l). We made a screening test for elastase-I level by ELISA test. Normal activity of this enzyme in feces is 200 мkg/g. We have used sonographic method for detection of pancreatic diseases in obese children due to echo-structure of parotid gland. The analysis and statistical data processing were made by computer program "Statistica 7.0" and MS Excel XP. Research data. Physical inspection of our patients confirms prevalence of І degree over II degree obesity (52.7 % and 47.3 %, respectively; Р < 0.05). We have confirmed valid risk factor of pancreatic lesion in obese children – presence of diabetes mellitus type I in close relatives (80 % and 65 %, χ2 = 2,05; Р < 0.05). The changes of exocrine function of the pancreas in children with the stage II obesity were established. Echographic signs of the pancreas lesion in teenagers with obesity indicate the presence of functional changes: edema of head or entire edema, partial increase of parenchymal echogenicity, insufficient enlargement of the duct of Wirsung.
L. V. Nykyfor, L. M. Rak, M. I. Kosevich
Likarska sprava pp 57-62; doi:10.31640/jvd.1-2.2020(8)

Abstract:
The article presents a clinical case of granular-cellular ovarian tumor (GCTJT) in a girl aged 17 years, which occurred in the practice of the doctors at the gynecological department of a hospital.
K. O. Kalko, S. M. Drogovoz, O. Ya. Mishchenko, L. B. Ivantsyk, K. O. Dehtiarova, М. М. Lukashuk, O. V. Gerush, A. O. Palamar, O. N. Korovenkova, S. I. Shevchenko
Likarska sprava pp 63-71; doi:10.31640/jvd.1-2.2020(9)

Abstract:
Determination of dependence of the efficiency and toxicity of drugs on the time of day or season is one of the most promising areas of modern experimental and clinical pharmacology. The aim of the study. Aim is to identify features of daily rhythms of silymarin influence on the state of antioxidant/prooxidant and cytolytic processes (the leading link in the implementation of hepatoprotective activity) with paracetamol in rats under conditions of acute toxic liver damage. Materials and methods. Chronopharmacological action features of silymarin were studied by use of the generic drug "Karsil" as an example (Sopharma, Bulgaria) with paracetamol in rats under conditions of acute toxic liver damage. The state of the processes of POL-AOS was evaluated by the content of TBA-active products (TBA-AP), the content of recovered glutathione, the activity of SOD, catalase in hepatocytes, and the cytolytic processes by the activity of ALT in serum. Results. There was established a certain chronoarchitectonics of the rhythms of the antioxidant protection system and the activity of the processes of peroxidation in rats under physiological conditions, which was not disturbed by paracetamol on the background of acute liver damage (with the exception of level of acrophase catalase activity). The same dynamics and commonality of rhythms occurred on the background of the use of silymarin. The maximum display of silymarin hepatoprotective activity was observed under conditions of its use in the morning (09.00) and in the evening (21.00). Conclusions. The use of silymarin during periods of maximal display of its hepatoprotective activity, in the morning (09.00) and in the evening (21.00) may be the way to increase its bioavailability. Chronopharmacological features of silymarin activity have been established and should be taken into account when to conduct its further chronopharmacological studies.
N. R. Matkovska
Likarska sprava pp 42-49; doi:10.31640/jvd.1-2.2020(6)

Abstract:
Introduction. The urgency of the problem of liver cirrhosis (LC) is caused by the increase in morbidity, prevalence, life-threatening complications, disability and increasing mortality of able-bodied population. The aim of the study was to examine the effect of complex treatment with ademethionine, arginine glutamate and rosuvastatin on changes in the haemostasis systemin patients with alcoholic liver cirrhosis (ALC) in combination with obesity. Research methods. The study included 105 patients diagnosed with ALC in combination with obesity. The assessment of the effectiveness of a three-month treatment regimen with ademethionine, arginine glutamate and rosuvastatin in obese patients with alcoholic liver cirrhosis (ALC) included indicators of synthetic liver function and hemostasis (total protein, albumin, fibrinogen, platelet count, factor Von Willebrand factor, activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), prothrombin index (PI), D-dimer, tissue plasminogen activator (tPA), 1 plasminogen activator (PAI-1), tPA/PAI-1 index, asymmetric dimethylarginine (ADMA)), as well as liver cirrhosis severity (Child-Pugh score) and 3-month MELD mortality score. Results. Decreased levels of total protein, albumin, fibrinogen, PI, platelet count and increased levels of Von Willebrand factor, prothrombin time (PT), APTT, TT, INR, D-dimer, tPA and PAI-1, ADMA were revealed. Such changes worsened with increasing liver cirrhosis decompensation and were accompanied by an increase in the Child-Pugh and MELD scores (P < 0.05). There was a more pronounced increase in levels of PAI-1 than tPA, that was accompanied by a decrease in tPA/PAI-1 index. A number of researchers indicate that an increase in PAI-1 levels can cause a hypercoagulable state, so its increase with a decrease in tPA/PAI-1 index in patients with ALC in combination with obesity indicates a risk of thrombogenic conditions. This is also evidenced by the increasing number of D-dimers. Therefore, the fibrinolytic/antifibrinolytic factors should be considered in the treatment of such patients to prevent LC complications. Conclusions. The inclusion of ademethionine, arginine glutamate and rosuvastatin in the treatment regimen for 3 months improved the levels of total protein, albumin, fibrinogen, PI, platelet count, Von Willebrand factor, PT, APTT, TT, INR, D-dimer, tPA and PAI-1, ADMA, which was accompanied by a decrease in Child-Pugh severity score and MELD 3-month mortality score.
V. E. Kazmirchuk, A. Yu. Galkin
Likarska sprava pp 3-7; doi:10.31640/jvd.1-2.2020(1)

Abstract:
The article outlines the causes of deaths when using a combination of azithromycin with Plaquenil®. Immunological substantiation of the main factors leading to vascular and pulmonary pathology (triggering angiotensin-converting enzyme and helper aggression in the lungs) is given. An immunotherapy method that eliminates the etiological links of the processes occurring during COVID-19 viremia is proposed. The method of prophylaxis of personnel in contact with patients is to use specific antibodies to coronaviruses found in immunoglobulin with intramuscular injection. A treatment schema for severe patients with COVID-19, SARS-2 is proposed.
S. Mostovyi, O. Dynnyk, N. Marunchyn
Likarska sprava pp 16-29; doi:10.31640/jvd.1-2.2020(3)

Abstract:
Aim. To determine the features of microcirculatory dysfunction and in patients with chronic ischemic heart disease, depending on the presence of concomitant diffuse liver disease. Materials and methods. We performed a prospective study on the basis of MC «Doctor Vera», as well as in the diagnostic department of Medbud Clinic between 2009 and 2019. A total of 187 patients were examined. Patients' blood flow was assessed by transthoracic echocardiography, wavelet analysis laser Doppler flowmetry (LDF). Results. In the analysis of indicators of microcirculatory dysfunction in patients with ischemic heart disease, statistically significant deterioration of wavelet analysis laser Doppler flowmetry was determined. In patients with ischemic heart disease and left ventricular ejection fraction < 40 %, indicators of wavelet analysis LDF were significantly lower. We also found that the severity of diffuse liver disease significantly disrupts peripheral blood flow (Р < 0.05). Conclusions. The results of intracardiac hemodynamics, microcirculatory dysfunction were first presented. In patients with isolated ischemic heart disease as the left ventricular EF decreased, a significant decrease in capillary blood flow was observed as a result of deterioration of central hemodynamics, development of atherosclerotic vascular changes, as well as an increase in their vascular tone. We have proved that in the presence of DLD in patients with ischemic heart disease and EF < 40 %, the degree of increase in peripheral resistance and impaired venous outflow were more pronounced due to the depletion of vasoactive substances production, impaired their excretion by hepatocytes due to irreversible morpho-functional changes in liver at the stage of decompensation of HF, severe fibrosis, the formation of regeneration nodes. In patients with LC, the most severe disorders of peripheral blood flow were determined according to the data of the digital capillaroscopy, which testifies to the influence of the degree of liver damage on the state of microcirculation.
P. G. Kravchun, M. O. Korzh, I. P. Dunaeva, F. S. Leontieva, I. V. Gusakov, S. O. Krapivko, V. Yu. Dielievska
Likarska sprava pp 8-15; doi:10.31640/jvd.1-2.2020(2)

Abstract:
A study of carbohydrate and lipid metabolism and immunological examination of patients with periprosthetic infection after knee and hip joint endoprosthetics (n = 16) and osteomyelitis (n = 20) was conducted. The patients with periprosthetic infection were characterized by anemia, eosinophilia, impaired glucose tolerance, cholestasis, predisposition to elevated atherogenesis, increased circulating immune complexes, autoimmune granulocytotoxic antibodies, immunoglobulins IgM, IgG, IgA and sensitization to synovial membrane and Staphylococcus aureus. The patients with osteomyelitis did not develop increased glucose and cholesterine level, but showed increased aminotransferases, thymol test, chondroitinsulfates, decrease of calcium and production of the leukocyte migration inhibition factor (LIF), both non-specific and to the antigens of cartilage tissue and sensitization to Streptococcus and E. coli. In patients with infections of the musculoskeletal system, glucose metabolism disturbances have been associated with the presence of autoimmune lymphocytotoxic antibodies, reduced production of LiF, both non-specific and to the antigens of synovial membrane. Atherogenesis was associated with increased circulating immune complexes, autoimmune lymphocytotoxic and granulocytotoxic antibodies, decreased LIF and sensitization to connective tissue antigens and pathogenic microorganisms, especially to Streptococcus and Proteus. Anemia was associated with increased autoimmune lymphocytotoxic antibodies, delayed-type sensitization to bone and cartilage tissue, to Staphylococcus and sensitization by accelerated type to E. coli and Proteus. Physicians should analyse immunological data while treating and monitoring the patients with connective tissue infections and disturbances of glucose and cholesterine metabolism.
I. I. Smolanka, A. O. Lyashenko, A. D. Loboda, D. E. Ryspaeva, O. M. Ivankova, I. V. Dosenko, I. I. Smolanka (Jun.), O. I. Sydorchuk
Likarska sprava pp 30-35; doi:10.31640/jvd.1-2.2020(4)

Abstract:
Radical surgery of the breast cancer (ВС) with the radical mastectomy often lead to a dysfunction of the upper lymb on the operation side. The symptom complex of disorders is manifested by swelling, numbness, paresthesias, pain syndrome of varying severity, heaviness, convulsions, spasms, and limited mobility. It is called postmastectomy syndrome (PMS). According to literature sources, the incidence of PMS is 60–80 % of all patients undergoing mastectomy. The severity of postmasectomy syndrome in patients with an inflammatory breast cancer (IBC) and locally advanced (non inflammatory) breast cancer (LABC) was compared. It turned out , that majority of patients with IBC had postmastectomy syndrome of the III degree according to Beltran while the patients with LABC (non inflammatory) – II. The limitation of mobility of the upper limb was also more pronounced in the IBC group, while the severity of pain syndrome was the same in both groups.
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